The stage for repeating the dose

- BENERJEE.P,

The stage for repeating the dose 

 It is necessary to know, as to when and on what definite indications the second dose has to be given. There are cases in which a hasty repetition of the dose, either due to the over-anxiety of the patient's guardian or due to want of patience on the part of the physician has caused serious mischief. Let us, therefore, bear in mind that, there should be no second dose unless it is called for by the indications of the case, because, it is not only that such a dose is unnecessary but also that it is positively mischievous. It must also be mentioned here that the occasion for a second dose, I am speaking of, may be there only when the first prescription has been correctly made and when as a result of that, the patient has made some response to the medicine. These advices must sound meaningless to those who care only for curing acute cases, as in acute cases there is no such all round response from the patient, but only a disappearance of symptoms. It is of course a fact, that there is perhaps not a single man who is not a chronic patient these days. But that does not necessarily mean that a chronic treatment will have to be made of every case that comes to you. Suppose, for example, here is an asthmatic coming to you for treatment. He complains-"Sir, I have an awful dyspnœa and cough at about 2 or 3 in the morning. Pray, do something for me; but as I am unable to stay here for a week or so, you will have to cure me quickly." Now, suppose, you give him a few doses of Kali Bichrom. or Ars. or some such remedy as indicated by his symptoms, in the 30th potency, and the patient is relieved of his dyspnœa and other attendant symptoms in a week. But this is not chronic treatment. Or suppose, the above patient comes to you for a full course of chronic treatment, but if you treat him as above and quiet down his sufferings with low potencies like the 30th or 200th, it is no chronic treatment either, though the patient's is a good case for a course of chronic treatment, because by such potencies as 30th or 200th you only remove his symptoms and relieve him of his sufferings, without annihilating the possibility of similar sufferings in the future, and this is purely acute treatment-which is always therapeutic patchwork. Chronic treatment, on the other hand, is an annihilation of the miasmatic basis of all disease manifestations and it ensures immunity from all future diseases, whether in the shape of asthma or in any other shape. Therefore, for a physician who cares only for removing the particular disease manifestation, the second or third doses, or second or third prescriptions etc. are all unintelligible verbosity. The question of a second dose or third dose may only arise in the case of chronic treatment, and the course of such treatment is long enough. It takes time from one to five, six or seven years, or even more. Dr. Kent took 11 years to cure a patient who had chorea.

 When however the patient does not want to undergo a course of chronic treatment though it may be necessary for a real cure of the man as a whole, high potencies should not be used. It is advisable to deal such cases with the 6th, 12th or the 30th at the utmost, because higher potencies might bring back the old symptoms at once and thereby necessitate a course of chronic treatment. Besides, it would only weaken the vital force unnecessarily; as the return of old symptoms, unless the case is treated to the end, means only a turmoil in the system, without any subsequent gain in strength on account of there being no final cure.
 Now, after the use of the first dose of the first prescription, if it has been correctly made, there is bound to be a change in the symptoms of the patient. And during the course of this change, some of those symptoms on which the selection was made will be disappearing and re-appearing, while some of the others will be aggravated and some ameliorated. Thus, this period of change will be a period of disorder, in the sense that there will be nothing stationary. And so long as this condition of "change and turmoil" continues, that is to say, so long as the condition of the patient does not settle down into a definite state of quietness indicating that the action of the first dose has been exhausted, there should be no interference with a second dose. The changed condition of the patient would tempt the physician into repeating the medicine but this should never be done, because these changes only show that the medicine is acting, and therefore, there must be no interference so long as it acts, that is to say, so long as these changes continue. It is only when these changes, this appearance and disappearance of symptoms and their aggravation and amelioration have passed away, and when the condition of the patient has reached a stage of quietness, i.e. , without any further changes, indicating that the medicine already given has almost ceased to act, that the question of a second dose should arise. It must be carefully remembered that any dose during the period of fleeting changes, after the first medicine, will spoil the whole case.

 It is clear now, that after the first dose of the first prescription there will be some fleeting changes and after these there will be a condition of calmness, in which there will be no constant change of symptoms. This "calm" will indicate that the action of the medicine has been exhausted and that some medicine has to be given now. You will, therefore, have to watch carefully and see if any of the symptoms on which your first prescription was based is returning. If your first prescription was correct, and if it was allowed to act without any interference with any other medicine, then those symptoms must return. There is no doubt about that. Thus, a mere condition of calmness after a series of changes is not all you want for repeating the dose. For giving a second dose, the return of the symptoms on which you made your first prescription is necessary, and when these have returned, the second dose should be given at once without any further waiting. The return of these symptoms will show that the treatment so far has been perfectly correct-that the first prescription has been perfectly homœopathic and that it has been allowed to act long enough without any interference. It is however not possible to say how long it may take for the original symptoms, (on which the first prescription was made) to return. It may take one or two months and even a full year at times. Each individual case is its own rule in this matter and no other rule can be laid down. The time taken is however always in proportion to a large number of factors, e.g. , the age, the vitality and the susceptibility of the patient, the chronicity of the case, the potency of the medicine used and so on.

 It may be argued that the advice for waiting after the use of the first dose is intelligible enough, but what should be the course to be followed in cases, where there is no change even after a long waiting?-This has already been explained to some extent, but let me say again that, in such cases, so that you may not have to wait too long after the first dose, you should repeat the dose every day or every alternate day slightly increasing the potency, as advised in the 6th edition of the Organon, and stop the dose as soon as some action of the medicine is perceived. This will avoid the risk of losing time unnecessarily, which may happen in case only one single dose of the medicine is used and in case when there is no re-action from that and yet you wait long enough. The repetition of the dose in increasingly higher potencies will accelerate the action, while stopping it simultaneously with the setting in of the re-action will not make all the several doses so many different units of action, but a single unit cumulated. In fact, the action obtained from such repeated doses is just like the action of one single dose, while there is no loss of time. If, however, there is no sign of re-action even after such repetition of doses, the mental condition of the patient should be studied at that stage, as it may be possible that there has been some improvement in the mind though it has not yet been reflected in the physical body. If there is some improvement in the mind, it is to be understood that the medicine has been acting, and in that case there should be no more doses and the action should be allowed to continue until the fleeting changes gradually appear and pass off and until there is a "calm" indicating the occasion for a second dose. If, however, from a study of the mental condition no improvement is perceived, it would become necessary to consider the correctness of the potency used, and you should then go higher up if the potency appears to have been too low.

 It however happens at times, that after the fleeting changes that occur on the use of the first dose, there is a long interval and there is no prospect of a return of the symptoms on which the first prescription was made. This stage is a stage of no symptoms. There is no appearance and disappearance of symptoms and yet those symptoms on which the first prescription was made are altogether absent. Practically there are no symptoms, or very few symptoms at this stage. It may therefore lead you to repeat the dose but you must avoid such repetition at any cost. You are a true Homœopath and you must understand that you made your first prescription as justified by the symptoms. There has been re-action from your prescription too, but this re-action has ceased and a stage of no symptoms has come in. It must be that the re-action is still continuing, only that it is not being perceived on the outside. Possibly the medicine is acting in the furthest interior of the patient's being. Possibly it is now setting the disorders in the innermost corners right and has therefore no time to show its action on the surface, and possibly it will act on the surface only when it has finished correcting the interior. In such cases, you have, therefore, to wait. You must not repeat the dose and you must not try a new prescription. You must not repeat the dose, as an additional dose when the medicine already given is acting, will bring on a severe aggravation; while you cannot try a second prescription, as there are no symptoms to prescribe upon. You have, therefore, to wait in such cases, and if you wait and watch for some time, you will find that the symptoms on which you prescribed will re-appear.

 Whenever you are tempted to repeat the dose or to re-prescribe in such cases, you should weigh the situation and argue that a number of symptoms are constantly coming and going and there is nothing certain-no totality of symptoms to prescribe upon, and therefore, there should be no prescription. Similarly, when there is a stage of no symptoms, there can be no prescription too, because, as a Homœpath, you cannot prescribe without having a totality of symptoms to prescribe upon. It is this very sound logic that should keep you from repeating the dose and from prescribing afresh during the stage of fleeting changes that comes after the first prescription as also during the stage of no symptoms that follows the stage of fleeting changes. This logic should therefore make you wait and watch, and there is no doubt that, the condition-the basis of your first prescription will soon return and offer you a case for a second dose of the same medicine either in the same or in a higher potency.

 After the use of the second dose there will be a change again and perhaps a re-appearance of the symptoms on which you prescribed, just as after the use of the first dose. This may repeat several times, and at every repetition of dose you should try to use a higher potency i.e. , as far as permitted by the gradual gain in vitality by the patient. And gradually there will re-appear the old symptoms that had disappeared and these will then gradually disappear of themselves indicating that a total cure has been effected. If however, you watch very carefully, you will find one very marvellous fact at all the several re-appearances of the symptoms on which the prescription was based, and it is this-the patient will be ever feeling greater and greater ease and relief in his mind in sipte of all the physical symptoms. This is a fact that will furnish you an unmistakable evidence of the correctness of your selection. How very beautiful! Just imagine, the patient has all the symptoms for which you prescribed and perhaps in an aggravated form, and yet he is feeling better in the mind!